This invention relates to tissue examination.
All women are at risk for breast cancer. This risk increases as a woman ages. Women are generally considered to be at increased risk for developing breast cancer if they have one or more of the following risk factors: a family history of breast cancer, a previous diagnosis of a malignant breast tumor or other gynecological cancers, hormonal factors, or not having had any children or having the first child later in their child bearing years. Even so, the majority of all breast cancers occur in women who apparently do not have identifiable risk factors.
Breast cancer cannot currently be prevented. But detecting and treating it at an early stage, when the tumor is small and has not spread beyond the breast, can increase the chances of survival significantly. However, not all breast cancers are currently detected at this early stage. Therefore, screening for breast cancer has become a critical aspect in the overall management of this disease.
The techniques currently used in the United States to screen for breast cancer and other breast conditions include monthly Breast Self Examination (BSE), mammography, and clinical breast examination.
Breast Self Examination is manual examination of a woman's breast tissue by the woman herself. During such examinations, it is typically recommended that a woman examine her breasts at the same time each month, 7-10 days after the first day of her last menstrual cycle. It is also typically recommended that she should report to her physician anything she feels that is new or that has changed since her prior exam.
A mammogram is an x-ray procedure that allows visualization of the internal structure of the breast. It is used as both a screening and diagnostic tool for breast abnormalities. It is generally recommended that women over 40 should have annual mammography so that any breast cancer can be detected early. However, many women still do not have annual mammographies.
Moreover, a mammography may miss a portion of breast cancers, especially in pre-menopausal women, in part because of reduced effectiveness of mammography in young women who generally have radiologically dense breast tissue. The accuracy of mammography also largely depends on the ability and experience of the radiologist who reads the images.
Clinical breast examinations are routinely performed by gynecologists or other primary care physicians. Generally, clinicians perform clinical breast examination to determine whether there are any foreign structures in the breast which may be carcinomas. Clinicians are interested in different kinds of information in performing a breast examination. For example, they are interested in the nature of foreign structures encountered and the degree of change since a previous examination (such as change in size of the structures and their total number). Clinical breast examination is an important tool in the early detection of breast cancer. Combined with mammography, clinical breast examination has been shown to be effective in detecting early breast cancer.
During clinical breast examination, clinicians generally examine the breast manually. Clinicians manipulate the tissue by hand, typically using the three middle fingers, to determine whether any foreign structures are encountered. If they discover a foreign structure during the examination, they may use their fingers to move the foreign structure and to examine its mobility, shape, density, and other characteristics.
In order to keep track of changes from examination to examination, clinicians generally use written records or their own recollection of the characteristics of various structures. If they decide during an examination that a structure warrants further examination because of changes since the last examination or because of the structure's current characteristics, they may prescribe further procedures such as mammography.
The effectiveness of manual clinical breast examination depends on several factors including the individual physician's proficiency, the duration of the examination, and the weight and age of the patient.